Ophthalmological apparatus for the breakdown of eye tissue

ABSTRACT

An ophthalmological apparatus includes a handle for manually holding and applying the ophthalmological apparatus, fastening abilities for fixing the ophthalmological apparatus at an eye, a light source, and a light projector for the focused projection of light pulses for punctiform tissue breakdown at a focal point in the interior of the eye tissue. The ophthalmological apparatus also includes a movement driver for moving the light projector. The movement of the light projector and therefore that of the focal point with the assistance of the movement driver permits a dimensioning of the optical projection system of the light projector which is substantially smaller than in the case of an ophthalmological apparatus where the focal point is moved exclusively by an optical projection system.

TECHNICAL FIELD

The present invention relates to an ophthalmological apparatus for thebreakdown of eye tissue. The invention relates, in particular, to anophthalmological apparatus which comprises a handle for manually holdingand applying the ophthalmological apparatus, which comprises fasteningmeans for fixing the ophthalmological apparatus at an eye, and whichcomprises a light source and a light projector, optically connected tothe light source, for the focussed projection of light pulses forpunctiform tissue breakdown at a focal point in the interior of the eyetissue.

PRIOR ART

Instances of ametropia such as myopia (short-sightedness), hyperopia(longsightedness or far-sightedness) or astigmatism can nowadays bepermanently corrected by refractive surgical treatment. Refractivesurgical treatments are surgical operations on the eye which change theoptical refractive power of the eye with the aim of bringing it as closeto a desired value as close as possible. One of the most importantmethods in refractive surgery is so-called laser-assisted in situkeratomileusis (LASIK) in which the interior of the cornea is removedwith the aid of a computer controlled eximer laser after a corneal flaphas previously been partially severed and folded away. In order toproduce the corneal flap, use is made of mechanical microkeratomes inwhich a driven scalpel cuts the corneal flap. Recently, such cornealflaps can also be cut with the aid of strongly focussed femtosecondlaser pulses, which have pulse widths of typically 100 fs to 1000 fs (1fs=10⁻¹⁵ s). The risks existing during use of a mechanically oscillatingscalpel are avoided by the use of a femtosecond laser. Such a system ismarketed by IntraLase Corp. in Irvine, Calif., USA under the name ofPulsion FS Laser. The overall size of the known systems havingfemtosecond lasers is comparable to the overall size of an eximer laser,its advantage being that the space required for the eximer laser isrequired once again in the treatment room for the femtosecond lasersystem. In addition, after the cutting of the corneal flap by thefemtosecond laser system, the patient must be transferred to the eximerlaser. The overall size of the femtosecond laser is determined, interalia, by the light source used, the scanner technology and the attendantbeam guidance systems. The laser beam is focussed inside a largestationary lens system by means of beam-deflecting optical elements ontothe tissue areas of the eye to be separated. For design reasons, themaximum achievable numerical aperture (NA, proportional to half the sineof the aperture angle of the objective) of the focussing optical systemis limited in this case (typically NA=0.2-0.3). For a given work area,for example the entire cornea, the scanning optics (typically an f-Thetaoptic) requires a minimum working distance. In conjunction with therequired movement and the achievable size of the beam-deflecting opticalelements, the working distance determines a design limit for thediameter of the scanning optics. A further upper design limit for thediameter follows from instances of shadings or collisions with bodyparts (eyebrows, nose). Even in the case of large diameters, it isalways possible to eliminate only a subarea of the optics with ascanning laser beam. The result of this is an upper design limit for theeffective useful numerical aperture of the optics. High apertures aredesirable because with high NA it is possible to produce small focalpoints, and thus a smaller cutting zone per pulse. Less gas is producedper pulse in smaller cutting zones than in large cutting zones. Moreprecise cuts can be made by means of smaller gas bubbles since, interalia, the cutting zones are not deformed by the internal gas pressure.In addition, high NA require disproportionately less energy per pulse tomake a cut. With a lower energy, there is also a reduction in thecavitation bubbles produced by the laser pulse, and this additionallyhas a positive effect on the cutting quality. Furthermore, the retina issubject to less stress from the more strongly diverging beams downstreamof the focal point given high NA. A further advantage is that for highNA local contaminants in the vicinity of the corneal surface have lesseffect in reducing the intensity at the focus.

Patent specification U.S. Pat. No. 5,549,632 describes anophthalmological apparatus having a laser source for the breakdown ofeye tissue, which can be used inter alia for cutting corneal flaps. Theapparatus in accordance with U.S. Pat. No. 5,549,632 comprises a lasersource and a projection head, optically connected to the laser source,in a housing separate from the laser source. The apparatus in accordancewith U.S. Pat. No. 5,549,632 also comprises beam control means whichcontrol the beam path of the laser pulses emitted by the laser sourcesuch that points in a reference frame fixed relative to the laser sourceare imaged via an optical connection onto corresponding points in areference frame fixed in relation to the projection head. The opticalconnection has to be designed in a complicated fashion as an articulatedmirror arm so that the light pulses deflected by the beam control meanscan be imaged relative to the reference frame of the hand-heldappliance. The connection of the projection head to an applanation platewhich can be permanently connected to the eye means that the fixedreference frame of the projection head in accordance with U.S. Pat. No.5,549,632 is permanently imaged onto the applanation plate and thus ontothe eye. In accordance with U.S. Pat. No. 5,549,632, the laser pulsesare led to the desired positions of the eye by using the beam controlmeans to control the position of the pulsed laser beam relative to theapplanation plate, and to image it onto the eye via the opticalconnection and the optical projection system of the projection head. Forexample, in order to carry out cuts of 5 to 15 mm in length, the opticalprojection system of the projection head must have optical lenses whosediameter is greater than the diameter of the eyeball. A projection headof such large dimension will cover the view onto the eye to be treated.Furthermore, the numerical aperture of the apparatus in accordance withU.S. Pat. No. 5,549,632 is small, as may be seen from the relativelysmall convergence of the beams.

A further ophthalmological apparatus for focussing laser pulses onto theeye is described in Patent U.S. Pat. No. 4,901,718. In accordance withU.S. Pat. No. 4,901,718 it is possible for the position of the laseroptics to be varied relative to the eye. The apparatus in accordancewith U.S. Pat. No. 4,901,718 also achieves only a small numericalaperture, this being due to the choice of the scanning method and thebeam guidance. As in the apparatus according to U.S. Pat. No. 5,549,632,the outlay on equipment for beam guidance is also considerable in theapparatus in accordance with U.S. Pat. No. 4,901,718.

Large lens systems also have the disadvantage of causing apparatuses tobecome heavy and unwieldy, thus complicating manual holding andapplication.

SUMMARY OF THE INVENTION

It is an object of the present invention to propose a newophthalmological apparatus for the breakdown of eye tissue, which doesnot have at least certain disadvantages of the prior art, and which issuitable, in particular, for punctiform tissue breakdown in the interiorof the eye tissue.

In accordance with the present invention, these objects are achieved, inparticular, by the elements of the independent claims. Furtheradvantageous embodiments also follow from the dependent claims and thedescription.

The above-named objects are achieved by the present invention by virtueof the fact that, in particular, a movement driver for moving the lightprojector is provided for an ophthalmological apparatus which comprisesa handle for manually holding and applying the ophthalmologicalapparatus, fastening means for fixing the ophthalmological apparatus atan eye, for example by low pressure, and a light source and a lightprojector, optically connected to the light source, for the focussedprojection of light pulses for punctiform tissue breakdown at a focalpoint in the interior of the eye tissue. Through the mechanical movementof the light projector, the movement driver advantageously permits thefocal point of the punctiform tissue breakdown to move automatically toa number of points in the interior of the eye tissue. Because the focalpoint is moved with the assistance of the movement driver, it ispossible in conjunction with the same action range of theophthalmological apparatus for the optical projection system of thelight projector to be of substantially smaller dimension than in thecase of an ophthalmological apparatus in which the focal point is movedexclusively by the optical projection system. In addition, owing to suchminiaturization of the optical projection system, it is possible toachieve a sharper focussing of the light pulses, that is to say asharper imaging of the light pulses at the focal point in the interiorof the eye tissue, since when the ophthalmological apparatus is appliedto the eye the distance between the optical projection system and theeye is reduced, and a smaller working distance results than in the caseof systems in which the focal point is moved in an exclusively opticalfashion, and a higher NA thereby results in conjunction with smallerdimensions. The sharper focussing of the light pulses permits moreprecise treatments with smoother cut surfaces and less stress for theeye.

The movement driver and the light projector are preferably set up andcoupled such that the light projector can be moved into a position inwhich at least a portion of the eye can be examined in top view uponfixing the ophthalmological apparatus at the eye. This enables the userto fix the ophthalmological apparatus at the eye to be treated given anunimpeded view of this eye.

The movement driver and the light projector are preferably set up andcoupled such that the light projector can be moved equidistantly from amovement surface. As a result, the focal point for the punctiform tissuebreakdown can be moved by the movement driver such that cuts and cutsurfaces are produced equidistantly from the movement surface in theinterior of the eye tissue.

The movement driver and the light projector are advantageously set upand coupled such that the light projector can be moved equidistantlyfrom a flat movement surface. As a result, the focal point for thepunctiform tissue breakdown can be moved by the movement driver suchthat cuts and flat cut surfaces are produced equidistantly from amovement plane in the interior of the eye tissue.

In a variant design, the movement driver is set up to move the lightprojector along a translation line equidistant from the movementsurface. Particularly in the case of a flat movement surface, it isthereby possible to use a simple mechanical displacement of the lightprojector along an equidistant translation axis to produce straight cutsin the interior of the eye tissue. In a variant design, theophthalmological apparatus comprises a second such movement driver whichis set up to move the light projector along a second translation lineequidistant from the movement surface. By the combination of twotranslatory movement drivers, it is thereby possible to use a simplemechanical displacement of the light projector along two translationlines to produce cut surfaces in the interior of the eye tissue, whichsurfaces are equidistant from the movement surface; flat cut surfacescan thus be produced in the case of the flat movement surface.

In a variant design, the movement driver is set up to move the lightprojector about an axis of rotation normal to the movement surface.Consequently, the focal point for the punctiform tissue breakdown can bemoved by the movement driver such that circular cuts equidistant fromthe (flat) movement surface are produced in the interior of the eyetissue.

In a variant design, the movement driver is set up to move the lightprojector along a translation line equidistant from the movementsurface, and the ophthalmological apparatus comprises a further movementdriver, which is set up to move the light projector about an axis ofrotation normal to the movement surface. Particularly in the case of aflat movement surface, the combination of displacement and rotation ofthe light projector can thus produce flat cut surfaces in the interiorof the eye tissue in a way similar to milling.

The ophthalmological apparatus is preferably set up to control thespacing between the focal point and the movement surface. By varying thespacing between the focal point and the movement surface, it is possibleto move the focal point for the punctiform tissue breakdown so as toproduce in the interior of the eye tissue cuts and cut surfaces whichare not equidistant from the movement surface and are, for example,perpendicular to the movement surface.

In a variant design, the ophthalmological apparatus is set up to controlthe position of the focal point along the axis of projection of thelight pulses. By varying the position of the focal point along the axisof projection of the light pulses, the spacing between the focal pointand the movement surface can be varied, as a result of which, asdescribed above, there are produced in the interior of the eye tissuecuts and cut surfaces which are not equidistant from the movementsurface and are, for example, perpendicular to the movement surface.

In a variant design, the light projector comprises light-deflectingoptical elements for the focussed projection of the light pulses along ascanning line. By using light-deflecting optical elements, typicallymovable light-deflecting optical elements, the focal point can be movedoptically such that tissue is broken down in the interior of the eyetissue in a punctiform fashion along the scanning line. By combiningthis optical movement of the focal point with the above-describedtranslatory or rotatory mechanical movements of the light projector, itis possible, in turn, for there to be produced in the interior of theeye tissue cut surfaces equidistant from the movement surface, or fromthe movement plane.

The ophthalmological apparatus preferably comprises a contact body whichcan be mounted onto the eye and is transparent at least at some pointsand is designed and arranged such that it places equidistantly from themovement surface an area of the eye which is contacted in the mountedstate. Since the focal point for the punctiform tissue breakdown in theinterior of the eye tissue is moved in a fashion equidistant from themovement surface, the contact body renders it possible in a simple wayfor there to be produced in the interior of the eye tissue cuts and cutsurfaces equidistant from the contacted area of the eye. If the focalpoint is moved in a fashion equidistant from the movement surface, useis preferably made of a contact body designed as an applanation bodywhich is arranged such that in the mounted state it applanates thecontacted area of the eye parallel to the movement surface. If the focalpoint is moved in a fashion equidistant from a concave or convexmovement surface, use if preferably made of a contact body designed as acontour body which is designed and arranged such that in the mountedstate it forms the contacted area of the eye parallel to the concave orconvex movement surface.

In a variant design, the contact body is permanently connected to thefastening means such that it is fixed at the eye to be treated.

In a variant design, the contact body is permanently connected to thelight projector. This produces a permanent reference from the lightprojector to the contact body, the contact body being moved togetherwith the light projector in the event of movement, preferably oftranslation.

In a variant design, the ophthalmological apparatus comprises a holdingapparatus for removably holding the contact body. Consequently,disposable contact bodies can be used to preserve hygiene and to avoidinfections. This advantage is achieved, in particular, when the contactbody is permanently connected to the fastening means, and both thecontact body and the fastening means can be connected to theophthalmological apparatus in a fashion capable of removal via theholding apparatus, and can be disposed or sterilized after use on apatient.

In a variant design, the light source comprises a femtosecond laser. Afemtosecond laser comprises a laser generator for producing laser pulseswith pulse widths of from 1 fs to 1 ps (1 fs=10⁻¹⁵ s). Laser pulses withsuch pulse widths permit the targeted punctiform breakdown of tissue inthe interior of the eye tissue, mechanical and thermal side effectsbeing strongly reduced in the surrounding tissue, such as are known fromlonger pulse widths.

In a variant design, the light source comprises a femtosecond laserwhich is designed as a fibre laser. A femtosecond fibre laser can bewound up in a space-saving fashion such that the ophthalmologicalapparatus can be designed as an inherently closed unit which comprisesthe light source and the light projector optically connected to thelight source, and which can be applied manually and can be fixed at theeye.

In a variant design, the light source comprises an optical oscillator,and the optical oscillator is connected to the light projector via anoptical expander, via an optical transport line and via an opticalcompressor, the optical transport line comprising an optical amplifier.The optical expander extends a short femtosecond laser pulse produced bymeans of the optical oscillator, for example by the factor 10⁴. Theextended laser pulse is of low intensity, and can be amplified to agreater amplitude by the optical amplifier. The optical compressorcompresses the amplified, extended laser pulse and thereby the intensityof the laser pulse to a multiple of the peak value for which the opticalamplifier is designed, for example by a factor of 10⁴. Laser pulses ofgreat intensity can thus be produced with the aid of an opticalamplifier of small dimension.

In a variant design, the optical transport line is designed as aphotonic crystal. The design of the optical transport line as a photoniccrystal, a so-called photonic crystal fibre, permits the transmissioncharacteristics to be substantially improved by comparison with theconventional fibre lines, such that high powers can be transmitted andthat the laser pulses are not “washed out” by dispersion.

In a variant design, the ophthalmological apparatus comprises carryingmeans for fastening the ophthalmological apparatus movably on an objectexternal to the ophthalmological apparatus, for example on an eximerlaser. Such carrying means permit the weight of the ophthalmologicalapparatus to be transferred to the external object, and permits the eyeto be treated to be relieved.

In a variant design, the ophthalmological apparatus is set up to movethe focal point such that the tissue breakdown in the interior of theeye tissue separates from the remaining eye tissue a tissue flap whichremains connected to the eye in a residual area.

In a variant design, the ophthalmological apparatus comprises controlmeans for controlling the position of the focal point in such a way thatthe tissue breakdown in the interior of the eye tissue separates fromthe remaining eye tissue a tissue piece which remains connected to theeye in a residual area, the tissue flap having lateral surfaces whichare produced by varying the spacing of the focal point from the movementsurface.

BRIEF DESCRIPTION OF THE DRAWINGS

A design of the present invention is described below with the aid of anexample. The example of the design is illustrated by the followingattached figures:

FIG. 1 shows a block diagram which schematically illustrates anophthalmological apparatus which comprises a handle, fastening means, alight source, a light projector optically connected to the light source,and a movement driver for moving the light projector.

FIG. 2 shows a block diagram which schematically illustrates a design ofthe ophthalmological apparatus having a contact body which can bemounted on the eye and is transparent at least at some points and whichis permanently connected to the fastening means.

FIG. 3 shows a block diagram which schematically illustrates a design ofthe ophthalmological apparatus having a contact body which can bemounted on the eye and is transparent at least at some points and whichis permanently connected to the light projector.

FIG. 4 a shows, with reference to an eye, the combination of twotranslatory movements for moving the focal point of the light projectorfor the purpose of punctiform tissue breakdown in the interior of theeye tissue.

FIGS. 4 b to 4 e show, with reference to an eye, various combinations ofa translatory and a rotatory movement for moving the focal point of thelight projector for the purpose of punctiform tissue breakdown in theinterior of the eye tissue.

FIG. 4 f shows, with reference to an eye, the combination of tworotatory movements for moving the focal point of the light projector forthe purpose of punctiform tissue breakdown in the interior of the eyetissue.

FIG. 5 a shows a block diagram which schematically illustrates a designof the ophthalmological apparatus with light-deflecting optical elementsfor the purpose of displacing the focal point along a scanning line, ina side view.

FIG. 5 b shows a block diagram which schematically illustrates a designof the ophthalmological apparatus with a movement driver for translatingthe light projector along an axis of translation, in a side view.

FIG. 5 c shows a block diagram which schematically illustrates a designof the ophthalmological apparatus with a movement driver for rotatingthe light projector about an axis of rotation, in side view.

FIG. 6 a shows a schematic cross section of a design of theophthalmological apparatus with a first movement drive for translatingthe light projector along an axis of translation, and with a secondmovement driver for rotating the light projector about an axis ofrotation.

FIG. 6 b shows a cross section which schematically illustrates a designof the bearing of the light projector for rotating the light projector.

FIG. 7 shows a block diagram which schematically illustrates a design ofthe ophthalmological apparatus which comprises a handle and a lightsource which are interconnected via an optical transport line.

FIG. 8 shows a block diagram which schematically illustrates a design ofthe ophthalmological apparatus which comprises carrying means forfastening the ophthalmological apparatus movably on an object externalto the ophthalmological apparatus.

FIG. 9 a shows a cross section of a tissue flap which, separated fromeye tissue, remains connected to the eye in a residual area.

FIG. 9 b shows a further cross section of the tissue flap illustrated inFIG. 9 a.

FIG. 10 a shows a cross section of a tissue piece which, separated fromeye tissue, remains connected to the eye in a residual area, and whichhas lateral surfaces.

FIG. 10 b shows a further cross section of the tissue piece illustratedin FIG. 10 a with lateral surfaces.

WAYS OF IMPLEMENTING THE INVENTION

Mutually corresponding components are denoted in FIGS. 1 to 8 byidentical reference symbols.

In FIGS. 1, 2, 3, 4 a to 4 f, 5 a to 5 c, 6 a, 9 a, 9 b, 10 a and 10 b,the reference numeral 2 denotes an eye, in particular a human eye.

In FIGS. 1, 2, 3, 5 a to 5 c, 6 a, 9 a, 9 b, 10 a and 10 b, thereference numeral 21 denotes eye tissue, in particular corneal tissue.

In FIGS. 1, 2, 3, 5 a to 5 c, 6 a, 7 and 8, the reference numeral 1denotes an ophthalmological apparatus which comprises a handle 14 formanually holding and applying the ophthalmological apparatus 1. Asillustrated schematically in FIGS. 7 and 8, the handle 14 of theophthalmological apparatus 1 can be designed in a projecting fashion.The ophthalmological apparatus 1 can, however, also be configured as ahand-held appliance such that its external form serves as a handle 14.

In FIGS. 1, 2, 3, 6 a, 7 and 8, the reference numeral denotes fasteningmeans 11 for fixing the ophthalmological apparatus 1 at the eye 2. Thefastening means 11 comprise, for example, a suction ring or a number ofsuction elements which fix the ophthalmological apparatus 1 at the eye 2by low pressure.

The ophthalmological apparatus 1 comprises a light projector 13 for thefocussed projection of light pulses 3 for punctiform tissue breakdown ata focal point F in the interior of the eye tissue 21. The lightprojector 13 is optically connected to a light source 12. The lightsource 12 comprises a femtosecond laser, that is to say a lasergenerator for generating laser pulses with pulse widths in thefemtosecond range of from 1 fs to 1 ps (1 fs=10⁻¹⁵ s). The light source12 comprises, for example, a femtosecond laser which is designed as afibre laser (femtosecond fibre laser).

As illustrated in FIGS. 1, 2 and 3, the ophthalmological apparatus 1 isdesigned as a unit which can be applied manually and be fixed at the eye2, and which comprises the light source 12 and the light projector 13optically connected to the light source 12. Light source 12 comprises,for example, an appropriately wound femtosecond fibre laser.

As illustrated in FIG. 7, in an alternative variant design theophthalmological apparatus 1 comprises a hand-held appliance 10 whichcan be applied manually and be fixed at the eye 2, and which comprises alight projector 13 as well as a light source 12 which is external to thehand-held appliance 10 and is connected to the light projector 13 via anoptical transport line 123. An appropriately designed ophthalmologicalapparatus 1 with such a hand-held appliance 10 is also illustratedschematically in FIG. 6 a. As illustrated schematically in FIG. 7, thelight source 12 comprises, for example, an optical oscillator 121 whichis connected to the light projector 13 via an optical expander 122, viathe optical transport line 123 and via an optical compressor 124, theoptical transport line 123 comprising an optical amplifier.Alternatively, high power can be transmitted into the hand-heldappliance 10 by using photonic crystals. The expander 122, amplifier andalso the compressor 124 can then be situated externally relative to thehand-held appliance 10.

As illustrated in FIG. 8, in a variant design the ophthalmologicalapparatus 1 can also be designed as a hand-held appliance 10 which canbe manually applied and fixed at the eye 2, and which is provided withcarrying means 7 in order to fasten the ophthalmological apparatus 1 orthe hand-held appliance 10 movably on an object 8 which is external inrelation to the ophthalmological apparatus 1 or the hand-held appliance10. The carrying means 7 comprise, for example, a number of carryingelements 71 which are movably interconnected via joints 72 and canabsorb the weight forces.

As illustrated in FIGS. 2, 3, 5 a to 5 c, and 6 a, the ophthalmologicalapparatus 1 comprises a contact body 16 which can be mounted on the eye2 and is transparent at least at some points. The contact body 16preferably consists of transparent material, for example plastic, with arefractive index corresponding to the eye tissue 21. The area of the eye2 which is contacted in the mounted state by the contact body 16, isdenoted as contact area 161. The contact body 16 has a surface 162averted from the contact area 161. The contact body 16 is preferablyconfigured as a plane-parallel applanation body, and the surface 162 isequidistant from the contact area 161 (see FIGS. 2, 3, 5 b, 5 c and 6a). However, the contact body 16 can also be configured as a contourbody which deforms the contacted area of the eye 2, for example inconcave or convex fashion (see FIG. 5 a). Both the applanation body andthe contact body 16 configured as contour body can be designed such thatthe surface 162 is not equidistant from the contact area 161. In analternative variant design, the contact body 16 can also have a cutoutthrough which the laser pulses are projected.

The contact body 16 is preferably permanently connected to the fasteningmeans 11, as illustrated in FIGS. 2 and 6 a. In an alternative design,the contact body 16 is permanently connected to the light projector 13,as illustrated in FIG. 3. The advantage thereby arises that the contactbody 16 and the light projector 13 are precisely adjusted relative toone another.

As illustrated schematically in FIGS. 2, 3 and 6 a, the ophthalmologicalapparatus 1 preferably comprises a holding apparatus 17 for removablyholding the contact body 16. In particular, when the contact body 16 ispermanently connected to the fastening means 11, as illustrated in FIGS.2 and 6 a, the holding apparatus 17 permits the removal of the contactbody 16 and the fastening means 11 connected thereto, after theapplication of the ophthalmological apparatus 1 to the eye 2 of apatient. As illustrated in FIGS. 1 and 3, a corresponding holding device17′ can also be provided for removably holding the fastening means 11,if the latter are not permanently connected to the contact body 16. Theremoved contact body 16 and/or fastening means 11 can either bediscarded or cleaned and sterilized. The holding device 17 or 17′ can,for example, be configured such that the contact body 16 or thefastening means 11 are removably connected to the ophthalmologicalapparatus 1 by means of a screw lock or by means of a snap lock.

Both the simple variant design of the ophthalmological apparatus 1without contact body 16, which is illustrated in FIG. 1, and thepreferred variant design in which a contact body 16 is permanentlyconnected to the fastening means 11, of which an example is illustratedin FIG. 2, and a further variant design, in which a contact body 16 ispermanently connected to the light projector 13, of which an example isillustrated in FIG. 3, have a movement driver 15 and further movementmeans 19 in order to move the focal point F of the light pulses 3projected by the light projector 13 such that it is possible to maketissue cuts 22 inside the eye tissue 21. The movement driver 15 is setup and arranged in order to move the light projector 13, and thus thefocal point F, mechanically in a fashion equidistant from a movementsurface.

FIGS. 4 a to 4 f respectively show a top view of the eye 2, the plane ofthe drawing preferably being parallel to the movement surface, fromwhich the light projector 13 can be moved equidistantly. In a variantdesign, the light projector 13 can be moved equidistantly from amovement surface which is not flat. The combinations of translatoryand/or rotatory movements, illustrated in FIGS. 4 a to 4 f, for themovement of the focal point F in the interior of the eye tissue 21 canbe combined in each case with the abovementioned simple, with theabovementioned preferred and with the abovementioned further variantdesigns of the ophthalmological apparatus 1. In order to execute thecombinations, illustrated in FIGS. 4 a to 4 f, of translatory and/orrotatory movements, the movement means 19 comprise a further movementdriver 19 b, 19 c or movable light-deflecting optical elements 19 a, asdescribed below.

The combination of two translatory movements for moving the focal pointF, which corresponds to a scanning operation, is illustrated in FIG. 4a. At least one of the translations is effected by a movement driver 15which moves the light projector 13 mechanically, for example in thex-direction. Appropriate designs with a movement driver 15 for atranslation of the light projector 13 in the x-direction are illustratedin FIGS. 2, 3 and 6 a. The second translation is effected either by afurther movement driver 19 b (see FIG. 5 b) which moves the lightprojector 13 mechanically in the y-direction, or by movablelight-deflecting optical elements 19 a (see FIG. 5 a) which project thelight pulses 3 along a scanning line in order to execute the tissue cut22 in a y-direction. Movable optical elements 19 a can be implemented,for example, as polygonal mirrors or galvanoscanners. In a variantdesign, translatory movements of the focal point F in the x-directionand in the y-direction are additionally superimposed by a fine movementof the focal point F, for example by means of optical microscans.

FIG. 4 b illustrates a combination of a translatory movement and arotary movement for moving the focal point F, which resembles a millingoperation, although only one cut is made in the interior of the eyetissue 21. The rotation is effected either by movable light-deflectingoptical elements which project the light pulses 3 along the rotationarrow ω, or by a movement driver 19 c (see FIG. 5 c or 6 a) which rotatethe light projector 13 about the axis of rotation z, that is to say arotation driver. The translation is effected by a movement driver 15which moves the axis of rotation z mechanically in the x-direction (seeFIG. 6 a, in particular).

FIG. 4 c illustrates a further combination of a translatory movement anda rotatory movement for moving the focal point F, which corresponds to aspiral movement as in the case of a record or a compact disc, or elsecan be designed in the form of concentric circles. The rotation iseffected by movable light-deflecting optical elements which project thelight pulses 3 along the rotation arrow ω. The translation is effectedby means of a movement driver 15 which executes a radial translation ofthe light projector 13 on the radius r emanating from the axis ofrotation z.

Illustrated in FIG. 4 d is a further combination of a translatorymovement and a rotatory movement for moving the focal point F, whichcorresponds the movement of a windscreen wiper of an automobile. Therotation is effected by a movement driver which pivots the lightprojector 13 to and fro about the axis of rotation z in accordance withthe rotation arrow ω. The translation is effected by movablelight-deflecting optical elements which project the light pulses 3 alonga scanning line s running through the axis of rotation z.

FIG. 4 e illustrates a further combination of a translatory movement anda rotatory movement for moving the focal point F. The rotation iseffected by a movement driver 19 c (see FIG. 5 c or 6 a) which rotatesthe light projector 13 about the axis of rotation z, that is to say arotation driver. The translation is effected by movable light-deflectingoptical elements which project the light pulses 3 along a scanning lines running through the axis of rotation z.

FIG. 4 f illustrates the combination of two rotatory movements formoving the focal point F. A first movement driver pivots the lightprojector 13 to and fro about the axis of rotation z₁ in accordance withthe rotation arrow w₁. The second rotation is effected either by asecond movement driver, which rotates the light projector 13 about theaxis of rotation z₂ in accordance with the rotation arrow w₂, or bymovable light-deflecting optical elements which project the light pulses3 along the rotation arrow w₂. The axis of rotation z₁ can also runthrough the centre Z.

It should be remarked here concerning the above-described combinationsof translatory and/or rotatory movements that the movements, executed bythe movable light-deflecting optical elements, of the focal point F areexecuted much more quickly (oscillation frequencies of higher than 100Hz are easy to implement technically) than the movements of the focalpoint F effected by mechanical movement drivers. Quick mechanicalscanning movements can be produced only by rotations, since there is noneed there to overcome inertia forces of oscillating masses. Bycombining quick movements along a scanning line and slow translationmovements perpendicular to the scanning line, it is possible to producecut surfaces just as quickly as is quick scanning also possible in thedirection perpendicular to the scanning line. It is thus advantageouslypossible to reduce the outlay on equipment (that is to say eliminationof a quick optical scanning axis) by suitably restricting theflexibility, that is to say by limiting the possible scanning patterns.Moreover, the limitation of flexibility can be used to reduce theoverall size of the ophthalmological apparatus 1.

As illustrated in FIG. 2, in the preferred variant design of theophthalmological apparatus 1, the movement driver 15 is designed andarranged such that the light projector 13 is displaced in thex-direction, which runs in the plane of the drawing. The light projector13 is displaced in the x-direction in a fashion equidistant from themovement surface by means of the movement driver 15, in particular alonga translation line or axis of translation. In FIG. 2, the movementsurface contains the x-axis, for example, and is perpendicular to theplane of the drawing. The contact body 16 is preferably arranged suchthat the contact area 161 is equidistant from the movement surface.Consequently, with the focal length of the light projector 13 unchanged,that is to say with an unchanged distance from the light projector 13 tothe focal point F, a tissue cut 22 is made in the interior of the eyetissue 21 in the x-direction in a fashion equidistant from the movementsurface. The same also holds for the further variant design, illustratedin FIG. 3, of the ophthalmological apparatus 1 in which, by contrastwith the preferred variant design, the contact body 16 is permanentlyconnected to the light projector 13. As may be seen from FIGS. 2 and 3,the movement driver 15 and the light projector 13 are coupled anddimensioned such that the light projector 13 can be moved into aposition in which at least a portion of the eye 2 can be examined by theuser in top view upon fixing the ophthalmological apparatus 1 at the eye2 (with light source 12 deactivated). The ophthalmological apparatus 1can thereby be applied easily and accurately, for example like aconventional microkeratome. The process can be carried out as usual bythe surgical microscope.

As illustrated schematically in FIGS. 2 and 3, the ophthalmologicalapparatus 1 comprises further movement means 19 for moving the focalpoint F in the y-direction perpendicular to the x-direction.

FIGS. 5 a, 5 b and 5 c illustrate various designs, which can be combinedwith the variant designs illustrated in FIGS. 2 and 3, of theophthalmological apparatus 1 with movement means 19 for moving the focalpoint F in the y-direction perpendicular to the x-direction. FIGS. 5 a,5 b and 5 c show schematically a view of a detail of theophthalmological apparatus 1 in the direction shown in FIGS. 2 and 3 bythe arrow A.

In the variant design in accordance with FIG. 5 a, the ophthalmologicalapparatus 1 comprises movable light-deflecting optical elements 19 awhich, for the purpose of making the tissue cut 22 in the y-direction,project the light pulses 3 onto a scanning line which runs in aequidistant fashion from a concave or convex movement surface. Thecontact body 16 is preferably of concave or convex design and arrangedsuch that the contact area 161 is equidistant from the concave or convexmovement surface. As a result, with an unchanged focal length of thelight projector 13, a tissue cut 22 is made in the interior of the eyetissue 21 in a fashion equidistant from the concave or convex movementsurface. The movable light-deflecting optical elements 19 a permit quickand repeated scanning in the y-direction (for example at a frequency offrom 100 to 1000 Hz). Examples of light-deflecting optical elements 19 acomprise, for instance, polygon scanners, galvanoscanners, tiltingmirrors (driven by piezo-actuators), microoptoelectromechanical systems(MicroOptoElectroMechanical Systems, MOEMS), acoustooptical modulators(AOM) or microlens array scanners which are controlled, for example, byappropriately programmed control means. The integration of anamorphoticoptics (for example cylindrical lens) along the scanning line permitshigh numerical apertures transverse to the scanning direction.

In the variant design in accordance with FIG. 5 b, the ophthalmologicalapparatus 1 comprises a further movement driver 19 b which is arrangedsuch that the light projector 13 is displaced mechanically along an axisof translation in the y-direction in a fashion equidistant from a flatmovement surface. The contact body 16 is arranged, in turn, such thatthe contact area 161 is equidistant from the movement surface. As aresult, with an unchanged focal length of the light projector 13 atissue cut 22 is made in the y-direction in the interior of the eyetissue 21 in a fashion equidistant from the flat movement surface.

In the variant design in accordance with FIG. 5 c, the ophthalmologicalapparatus 1 comprises a further movement driver 19 c, which is designedand arranged such that the light projector 13 is rotated in accordancewith the rotation arrow ω about one or two axis/axes of rotation znormal to a flat movement surface. The contact body 16 is arranged, inturn, such that the contact area 161 is equidistant from the movementsurface. As a result, with an unchanged focal length of the lightprojector 13 a circular tissue cut 22 is made in the interior of the eyetissue 21 in a fashion equidistant from the flat movement surface.

In order to move the focal point F in the z-direction, which isperpendicular to the x- and y-directions and shown in FIGS. 5 c and 6 a,the ophthalmological apparatus 1 is set up to control the spacingbetween the focal point F and the movement surface. In a variant design,the movement means 19 comprise a further movement driver (notillustrated), which moves the light projector 13 in the z-direction inorder to vary the spacing between the focal point F and the movementsurface. However, the ophthalmological apparatus 1 is preferably set upto control the position of the focal point F along the axis ofprojection 31 of the light pulses 3, that is to say to vary the positionof the focal point F by means of optical elements. The focal length ofthe light projector 13 can be varied, for example, by moving the lens 4in the x′-direction, as shown in FIG. 6 a. By moving the focal point Fin the z-direction, it is possible to make tissue cuts in the interiorof the eye tissue 21 in the z-direction, vertical to the movementsurface.

FIG. 6 a shows a schematic cross section of a design of theophthalmological apparatus 1 in the state mounted on the eye 2. Thedesign shown in FIG. 6 a of the ophthalmological apparatus 1 correspondsto a combination of the variant designs shown in FIGS. 2 and 5 c, andpermits movements of the focal point F in accordance with FIG. 4 b. Thedesign shown in FIG. 6 a of the ophthalmological apparatus 1 comprises ahand-held appliance 10 with a light projector which is connected via anoptical transport line 123 to a light source 12 external to thehand-held appliance 10. In accordance with the design illustrated inFIG. 6 a, the light projector comprises the hollow body 13′, the mirrors5′ and lens 6, attached to the hollow body 13′, as well as the lens 4and the mirror 5. Light pulses 3 generated in the light source 12 arefocussed at the focal point F via the lens 4, the mirrors 5 and 5′ andvia the lens 6, and projected into the interior of the eye tissue 21.The hollow body 13′ is mounted by means of the bearing 18 such that itcan rotate about the axis of rotation z. FIG. 6 b shows a cross sectionthrough the bearing 18 and the hollow body 13′ of the light projector atthe point shown in FIG. 6 a by the arrow B, the arrangement of ballbearings 18′ being purely schematic. It will be understood by the personskilled in the art that other types of bearing are possible. The hollowbody 13′ of the light projector is rotated about the axis of rotation zin a fashion driven by the movement driver 19 c via the drive element191. The mirror 5 is rigidly connected to the movement driver 19 c andreflects incoming light pulses 3 onto the mirrors 5′, which arepermanently connected to the rotatable hollow body 13′ of the lightprojector and move about the axis of rotation z with the hollow body13′. The hollow body 13′ of the light projector, the bearings 18 and themovement driver 19 c are attached to a carrier 192 which can bedisplaced mechanically along an axis of translation in the x-directionby the movement driver 15. As indicated in FIG. 6 a, theophthalmological apparatus 1 comprises a housing (illustrated by dashes)which serves as a handle 14 and is configured to enable to translationmovement in the x-direction and the rotation about the axis of rotationz. The housing configured as a handle 14 has a cutout 141 which permitsan unimpeded view of the eye 2 from the direction indicated by thearrows V. It may be seen from FIG. 6 a how it is possible by combiningthe mechanical scanning movements and small projection optics toimplement a compact ophthalmological apparatus 1 which nevertheless hasa very high numerical aperture (the design in accordance with FIG. 6 ahas approximately a numerical aperture of 0.5).

FIGS. 9 a, 9 b, 10 a and 10 b show examples of tissue pieces which areseparated from the remaining eye tissue 21 by the ophthalmologicalapparatus 1 by means of focussed projection of light pulses onto focalpoints F in the interior of the eye tissue 21 and by the punctiformtissue breakdown effected thereby. The tissue flap 23 illustrated inFIG. 9 a is produced in the applanated state of the eye 2 by a flattissue cut 22 in the interior of the eye tissue 21, and remainsconnected to the eye 2 in a residual area 26. FIG. 9 b shows a crosssection through the tissue flap 23 at the point which is indicated inFIG. 9 a by the arrows C. The tissue piece 24 shown in FIG. 10 a is alsoproduced in the applanated state of the eye 2 by a flat tissue cut 22 inthe interior of the eye tissue 21. The tissue piece 24 likewise remainsconnected to the eye 2 in a residual area 26, and has lateral surfaces25 which are produced by vertical cuts. FIG. 10 b shows a cross sectionthrough the tissue piece 24 with the lateral surfaces 25 at the pointindicated in FIG. 10 a by the arrows D. Other edge shapes are possibleat the location of the lateral surfaces 25 when, for example, lens 4 inFIG. 6 a is displaced vertically in addition. The base surfaces 27 ofthe tissue flap 23 illustrated in FIG. 9 a and of the tissue piece 24shown in FIG. 10 a are produced by the flat tissue cut 22, that is tosay by moving the focal point F in a fashion equidistant from themovement surface. In order to limit the action range within which thefocal point F can be moved, the movement driver 15 and the movementmeans 19, in particular 19 a, 19 b and 19 c, are limited mechanicallyand/or by programmable control means in their movement range.Particularly for the movement of the focal point F in a fashionequidistant from the movement surface, the movement driver 15 and themovement means 19, in particular 19 a, 19 b and 19 c, are preferablyguided mechanically. Movement surfaces of great precision can thereby berealized by mechanical guides. Precise movement surfaces can easily beimplemented by mechanical guides particularly in the case of a constantworking distance of the light projector 13. Programmable control meansare suitable, in particular, for the configuration of individuallydimensioned tissue cuts 22 and/or of tissue cuts for separating tissuepieces 24 which cannot just be made by simple flat tissue cuts 22. Theprogrammable control means comprise, for example, a processor and amemory in which there are stored programmes and cut parameters, ornon-programmable electronic circuits which comprise memories for storingcut parameters.

During application of the ophthalmological apparatus 1, the lightprojector 13 is preferably firstly displaced by means of the movementdriver 15 such that at least a portion of the eye 2 can be freelyexamined in top view. Thereafter, the ophthalmological apparatus 1 ismounted on the eye 2 in the desired area and fixed at the eye 2 with theaid of the fastening means 11. If appropriate, the contact body 16 hasreference marks for accurate positioning of the ophthalmologicalapparatus 1 on the eye. The ophthalmological apparatus 1 is thenactivated, and the focal point F is moved automatically by the movementdriver 15 and the movement means 19, in particular 19 a, 19 b and 19 c,preferably under mechanical guidance and limitation and/or underprogrammed control.

1. An ophthalmological apparatus, comprising: a light source, and anappliance for manual application onto an eye, the applicationcomprising: fastening means configured to fix the appliance on the eye,a light projector, optically connected to the light source, for thefocused projection of light pulses for punctiform tissue breakdown at afocal point in the interior of the eye tissue, and having a projectionaxis, a movement driver configured to mechanically move the lightprojector and its projection axis with the appliance being fixed on theeye, to move the focal point of the punctiform tissue breakdown andthereby produce cuts by moving said focal point.
 2. The ophthalmologicalapparatus according to claim 1, wherein the movement driver and thelight projector are set up and coupled such that the light projector ismovable into a position in which at least a portion of the eye can beexamined in top view upon fixing the appliance on the eye.
 3. Theophthalmological apparatus according to claim 1, wherein the movementdriver and the light projector are set up and coupled such that thelight projector can be moved equidistantly from a movement surface. 4.The ophthalmological apparatus according to claim 3, wherein themovement driver is set up to move the light projector along atranslation line equidistant from the movement surface.
 5. Theophthalmological apparatus according to claim 3, wherein the movementdriver is set up to move the light projector about an axis of rotationnormal to the movement surface.
 6. The ophthalmological apparatusaccording to claim 3, wherein the movement driver is set up to move thelight projector along a translation line equidistant from the movementsurface, and in that the appliance comprises a further movement driver,which is set up to move the light projector about an axis of rotationnormal to the movement surface.
 7. The ophthalmological apparatusaccording to claim 3, wherein the ophthalmological apparatus is set upto control the spacing between the focal point and the movement surface.8. The ophthalmological apparatus according to claim 1, wherein theophthalmological apparatus is set up to control the position of thefocal point along the axis of projection of the light pulses.
 9. Theophthalmological apparatus according to claim 1, wherein the lightprojector comprises light-deflecting optical elements for the focussedprojection of the light pulses along a scanning line.
 10. Theophthalmological apparatus according to claim 3, wherein theophthalmological apparatus comprises a contact body which can be mountedonto the eye and is transparent at least at some points and is designedand arranged such that it places equidistantly from the movement surfacean area of the eye which is contacted in the mounted state.
 11. Theophthalmological apparatus according to claim 10, wherein the contactbody is of plane-parallel configuration.
 12. The ophthalmologicalapparatus according to claim 10, wherein the contact body is permanentlyconnected to the fastening means.
 13. The ophthalmological apparatusaccording to claim 10, wherein the contact body is permanently connectedto the light projector.
 14. The ophthalmological apparatus according toclaim 10, wherein the ophthalmological apparatus comprises a holdingapparatus for removably holding the contact body.
 15. Theophthalmological apparatus according to claim 1, wherein the movementdriver and the light projector are set up and coupled such that thelight projector can be moved equidistantly from a flat movement surface.16. The ophthalmological apparatus according to claim 1, wherein thelight source comprises a femtosecond laser.
 17. The ophthalmologicalapparatus according to claim 16, wherein the femtosecond laser isdesigned as a fibre laser.
 18. The ophthalmological apparatus accordingto claim 1, wherein the light source is connected to the light projectorvia an optical transport line which is designed as a photonic crystal.19. The ophthalmological apparatus according to claim 1, wherein thelight source comprises an optical oscillator, and in that the opticaloscillator is connected to the light projector via an optical expander,via an optical transport line and via an optical compressor, the opticaltransport line comprising an optical amplifier.
 20. The ophthalmologicalapparatus according to claim 19, wherein the optical transport line isdesigned as a photonic crystal.
 21. The ophthalmological apparatusaccording to claim 1, wherein the fastening means are set up to fix theappliance by low pressure to the eye.
 22. The ophthalmological apparatusaccording to claim 1, further comprising carrying means for fasteningthe appliance movably on an object external to the appliance.
 23. Theophthalmological apparatus according to claim 1, wherein theophthalmological apparatus is set up to move the focal point such thatthe tissue breakdown in the interior of the eye tissue separates fromthe remaining eye tissue a tissue flap which remains connected to theeye in a residual area.
 24. The ophthalmological apparatus according toclaim 3, wherein the ophthalmological apparatus further comprisescontrol means for controlling the position of the focal point in such away that the tissue breakdown in the interior of the eye tissueseparates from the remaining eye tissue a tissue piece which remainsconnected to the eye in a residual area, the tissue piece having lateralsurfaces which are produced by varying the spacing of the focal pointfrom the movement surface.
 25. The ophthalmological apparatus accordingto claim 1, wherein the ophthalmological apparatus is designed as aunit, which unit can be applied manually and can be fixed to the eye,and which unit comprises the light source and the light projectoroptically connected to the light source.
 26. An ophthalmologicalapparatus, comprising: a light source, and an appliance for manualapplication onto an eye, the appliance comprising: fastening meansconfigured to fix the appliance on the eye, a light projector, opticallyconnected to the light source, for the focussed projection of lightpulses for punctiform tissue breakdown at a focal point in the interiorof the eye tissue, and a movement driver for moving the light projectorsuch that the focal point at the punctiform tissue breakdown is movedautomatically and cuts are produced from moving the focal point of thepunctiform breakdown by the movement driver.
 27. An ophthalmologicalapparatus comprising: a light source, fastening means for fixing theophthalmological apparatus onto an eye, a light projector, opticallyconnected to the light source, for the focussed projection of lightpulses for punctiform tissue breakdown at a focal point in the interiorof the eye tissue, and a movement driver for moving the light projectorsuch that the focal point of the punctiform tissue breakdown is movedand cuts are produced in the interior of the eye tissue.